Provider Demographics
NPI:1932159852
Name:COOPER, GEOFFREY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:JAMES
Last Name:COOPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 EXECUTIVE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4875
Mailing Address - Country:US
Mailing Address - Phone:402-990-3469
Mailing Address - Fax:
Practice Address - Street 1:2240 EXECUTIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4875
Practice Address - Country:US
Practice Address - Phone:402-990-3469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine